Effect of hygiene interventions on acute respiratory infections in childcare, school and domestic settings in low‐ and middle‐income countries: a systematic review. TMIH, May 2018. Evidence suggests that hand hygiene interventions delivered in childcare, school and domestic settings can reduce ARI morbidity, but effectiveness varies according to setting, intervention target, and intervention compliance.
Is Community-Led Total Sanitation connected to the rebuilding of latrines? Quantitative evidence from Mozambique. PLoS One, May 22. Logistic regression and mediation analyses reveal that latrine rebuilding depends on education, soil conditions, social cohesion, and a feeling of being safe from diarrhea, the perception that many other community members own a latrine, and high confidence in personal ability to repair or rebuild a broken latrine.
Access to Household Water Quality Information Leads to Safer Water: A Cluster Randomized Controlled Trial in India. Environ. Sci. Technol., April 11, 2018.
Household-specific feedback on the microbiological safety of drinking water may result in changes to water management practices that reduce exposure risks. We conducted a randomized, controlled trial in India to determine if information on household drinking water quality could change behavior and improve microbiological quality as indicated by Escherichia coli counts. We randomly assigned 589 participating households to one of three arms: (1) a messaging-only arm receiving messaging on safe water management (n = 237); (2) a standard testing arm receiving the same messaging plus laboratory E. coli testing results specific to that household’s drinking water (n = 173); and (3) a test kit arm receiving messaging plus low-cost E. coli tests that could be used at the household’s discretion (n = 179). Self-reported water treatment increased significantly in both the standard testing arm and the test kit arm between baseline and follow-up one month later. Mean log10 E. coli counts per 100 mL in household stored drinking water increased in the messaging-only arm from 1.42 to 1.87, while decreasing in the standard testing arm (1.38 to 0.89, 65% relative reduction) and the test kit arm (1.08 to 0.65, 76% relative reduction). Findings indicate that household-specific water quality information can improve both behaviors and drinking water quality.
The health benefits of point-of-use (POU) water treatment can only be realized through high adherence: correct, consistent, and sustained use. We conducted parallel randomized, longitudinal crossover trials measuring short-term adherence to two single-use flocculant–disinfectant sachets in Pakistan and Zambia. In both trials, adherence declined sharply for both products over the eight week surveillance periods, with overall lower adherence to both products in Zambia. There was no significant difference in adherence between the two products. Estimated median daily production of treated water dropped over the crossover period from 2.5 to 1.4 L person–1 day–1 (46% decline) in Pakistan and from 1.4 to 1.1 L person–1 day–1 (21% decline) in Zambia. The percentage of surveillance points with detectable total chlorine in household drinking water declined from 70% to 49% in Pakistan and rose marginally from 28% to 30% in Zambia. The relatively low and decreasing adherence observed in this study suggests that these products would have provided little protection from waterborne disease risk in these settings. Our findings underscore the challenge of achieving high adherence to POU water treatment, even under conditions of short-term adoption with intensive follow-up.
WaSH Policy Research Digest: Issue #8, May 2018: Remote Monitoring of Handpump Functionality. UNC Water Institute, May 2018.
Data from remote sensors on handpump uptime and failures can increase operational performance, but only when combined with a highly responsive maintenance service. Advanced data analytics open up the possibility of predicting faults and undertaking pre-emptive repairs, potentially reducing downtime to zero, but this must be weighed against the cost of sensors. Data from remote sensors could contribute to regulatory and contractual oversight, supporting the creation of rural water utilities and effective performance contracts.